New approach to ADHD

By Margaret RiceMarch 13 2003

The Federal Government has approved the use of long-acting Ritalin medication in the treatment of children with attention deficit hyperactivity disorder (ADHD).

Ritalin LA (long-acting methylphenidate), which is manufactured by Novartis, was approved for use in Australia in mid-January. Until then Ritalin, one of the most popular drug therapies for ADHD, had to be taken every four hours.

The newer eight-hour formulation allows children to side-step the issues that arise if they have to take the drug during school hours.

There are other new drugs for ADHD hovering in the wings.

Janssen-Cilag is seeking approval for its long-acting methylphenidate preparation, Concerta, to be sold in Australia and Eli Lilly is seeking approval for Strattera (atomexitine), a non-stimulant that has a different action to existing drugs.");document.write("

advertisement

");
}
}
// -->

The registration of Ritalin LA comes at a time when the NSW Parliamentary Committee on Children and Young People was to have produced its report: The Use of Prescription Drugs and Over the Counter Medications by Children and Young People.

Originally due in December last year, the committee chairman, Labor MP David Campbell, says it won't be released now until after the election next weekend. It will be making recommendations about the prescription of dexamphetamine, the most popular medication for ADHD in Australia.

The WA Government has recently introduced measures to tighten prescription of dexamphetamine because of problems described in a report published by its Office of Mental Health last November, such as older school children selling their short-acting medication at school.

In Australia more dexamphetamine is prescribed for ADHD than Ritalin, the reverse of the situation in countries such as the US. Dexamphetamine is cheaper here because it attracts a pharmaceutical benefit scheme rebate, whereas Ritalin doesn't.

According to the University of Queensland, in the year from July 2001 the total expenditure by the PBS for dexamphetamine was $3,794,612. It estimated that Ritalin, not covered by the PBS, costs families $50 a month.

University figures show that Ritalin use has increased from 1.56 million tablets prescribed in 1984 to 19.33 million in 2001, while dexamphetamine use for the same period has risen from 8.39 million to 38.43 million tablets.

In contrast to the level of financial support for medication, Australia tends to have a poor record when it comes to long-term financial support for good behavioural interventions for ADHD.

Yet local and overseas research continues to show behavioural interventions are very effective in the management of ADHD and medication should complement behavioural intervention, rather than the other way around.

A Seattle study published in February's American Journal of Developmental and Behavioural Pediatrics found that ADHD children benefit when both children and parents are taught behavioural and social skills as a supplement to medical treatment.

This echoes the results of an Australian study last year by the University of Queensland's Centre of General Practice. The head of the research team, Professor Paul Glasziou, says that many children with ADHD may be receiving little benefit from their current medication and should be using non-drug treatments or other medications.

However, he says, some stimulant medications do work for some children: "Preliminary results are providing feedback on this, with 19 out of the 42 children tested so far showing definite benefit from their ADHD medication."

ADHD has a big impact and estimates of its incidence vary because of the different criteria used in its diagnosis. The WA Office of Mental Health report shows that up to 6 per cent of schoolchildren in that state have ADHD, a figure that is mirrored around the world.

But the child and adolescent component of the National Survey of Mental Health and Wellbeing, published in 2000, which surveyed more than 4000 people, reported that 11 per cent of parents identified their child as suffering symptoms of ADHD.

If this is true, drug intervention is underused because only 1 per cent of the Australian population is treated with drugs for ADHD, according to Dr Paul Hutchins, the head of child development at the Children's Hospital Westmead and chairman of NSW Health's stimulants sub-committee.

Sociologists see ADHD as a social phenomenon as much as a medical one. For instance, associate professor David McCallum, of the Department of Social Inquiry at Victoria University in Melbourne, says that in some communities identified as being at the margins of society about 50 per cent of the children have been diagnosed with ADHD.

Professor David Hay, the head of the school of Psychology at Curtin University, Bentley, WA, believes that ADHD is under-diagnosed and that more children could benefit from appropriate prescription.

But he also agrees with those pediatricians and child psychiatrists such as Hutchins who say recommendations for improved resourcing of behavioural interventions are often ignored.

Hutchins says that in Australia "we have the professional skills to manage the problem, but we don't have the extent of the services that are needed".

He says his Talk, Time, Teamwork booklet, a co-operative strategy for teachers and the medical profession, was distributed throughout NSW schools in the 1990s, but its use has been disappointing.

Despite knowledge that a combined approach works, Hutchins says, Australian governments consistently fail to invest in behavioural and social interventions because these are more complex.